Senate Investigations Committee
Releases Full Report on Pharmacy Benefit Managers
In January of 2019, a new Senate committee, established earlier this year by Senator James Skoufis, coordinated with the Senate Committee on Health, and opened an investigation into the practices of Pharmacy Benefit Managers (PBMs) in New York State. Looking into what is akin to forcing a monopoly on patients, Skoufis said “Every single day in this state, someone is forced to choose between buying medication that they need and buying groceries for the week. This is an atrocity and a failure of government oversight. Price hiking has plagued consumers for decades and we are currently at a point where it has gotten out of control.
The investigative team held numerous meetings and discussions with representatives from three PBMs, CVS Caremark, Express Scripts, and OptumRx, regarding the requests, investigatory scope, and recommending voluntary actions by the PBMs to adjust industry practices to better serve consumers. They will ultimately have the ultimate choice of following new recommendations or new laws.
Legislative recommendations include:
- Regulate the practices of spread pricing in all pharmacy benefit contracts
- Enhance the transparency of MAC appeals
- Require the licensing and registration of PBMs to enhance accountability and oversight by instituting a fiduciary duty for their clients
- Prohibit PBMs from mandating that patients use specialty and mail order pharmacies
- Providing for the adequate and transparent reimbursements for pharmacies
- Require PBMs to pass-through all discounts or rebates received from drug manufacturers to its Medicaid managed care clients